Extratemporal Facial Nerve: Surgical Landmarks, Risk Zones, and a Practical Framework for Safe Dissection.

PURPOSE: To provide a clinically relevant synthesis of the extratemporal facial nerve, focusing on anatomical variability, surgical landmarks, and regions at risk of injury.

METHOD: A narrative review of the literature was performed, examining the extratemporal facial nerve across the parotid, midface, jawline, perioral, temporal, periorbital, and frontal regions. Emphasis was placed on branching patterns, depth relative to fascial planes, and surgically relevant anatomical relationships.

FINDINGS: The extratemporal facial nerve demonstrates considerable variability in course and branching. Regions where the nerve follows a superficial or less predictable trajectory represent areas of increased surgical risk. In contrast, consistent fascial planes and defined anatomical spaces may provide relatively safer corridors for dissection.

CONCLUSION

A region-based, plane-oriented understanding of facial nerve anatomy reflects intraoperative conditions more closely than landmark-based descriptions alone. This approach may improve surgical orientation and reduce the risk of iatrogenic injury, particularly in procedures involving the parotid and midface.

LEVEL OF EVIDENCE: Level 5 (Narrative Review).